title: Pneumocystis pneumonia in patients treated with long-term steroid therapy for symptom palliation: a neglected infection in palliative care.
abstract: We report 3 cases of pneumocystis pneumonia (PCP) in patients with advanced cancer who received palliative care. All patients received long-term steroid therapy for symptom management. A diagnosis of PCP was based on clinical symptoms and a positive Pneumocystis jiroveci polymerase chain reaction test from induced sputum specimens. Despite appropriate treatment, only 1 patient recovered from PCP. Long-term steroid, often prescribed in palliative care settings, is the most common risk factor for PCP in non-HIV patients. Pneumocystis pneumonia may cause distressing symptoms such as severe dyspnea, and the mortality rate is high. Therefore, it is important to consider PCP prophylaxis for high-risk patients and to diagnose PCP early and provide appropriate treatment to alleviate PCP-related symptoms and avert unnecessary shortening of a patient's life expectancy.
authors.affiliation: Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan Palliative Care Team, Teine Keijinkai Hospital, Sapporo, Japan Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan ikagoro@pop06.odn.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nagai
authors.affiliation: Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kiuchi
authors.affiliation: Palliative Care Team, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Mina
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Palliative Care Team, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Hisahara
authors.affiliation: Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hisanaga
mesh_terms: D001623:Betamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors
chemical_list: D003907:Dexamethasone; D001623:Betamethasone
keywords: advanced cancer; palliative care; pneumocystis pneumonia; prophylaxis; steroid